Provider Demographics
NPI:1144356361
Name:TAKAYAMA, RYOKO (LAC)
Entity type:Individual
Prefix:MS
First Name:RYOKO
Middle Name:
Last Name:TAKAYAMA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 BARRANCA PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4671
Mailing Address - Country:US
Mailing Address - Phone:949-836-2857
Mailing Address - Fax:
Practice Address - Street 1:4950 BARRANCA PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4671
Practice Address - Country:US
Practice Address - Phone:949-836-2857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10106171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist